Acute adhesive intestinal obstruction - retrospective analysis

Background. Gallstone ileus is a pathology characterized by a variety of clinical manifestations and types of the course. Therefore, it is difficult in the diagnostic and therapeutic aspect and leads to unsatisfactory treatment results. The aim of the work is to find out the features of diagnosis and treatment of patients with gallstone ileus. Materials and methods. A retrospective analysis was performed of 51 medical records of inpatients with gallstone obstruction operated in the clinic from 1990 to 2020. Women aged 61 to 85 (median of 74.20 ± 12.95) years predominated — 44 (86.3 %). Most patients (81 %) had concomitant diseases, which in combination with gallstone ileus caused high surgical risk: coronary heart disease — 26 (51 %), essential hypertension — 11 (21.6 %), diabetes mellitus — 3 (5.9 %), obesity — 1 (2 %). Results. During the clinical, laboratory and instrumental examinations, the following preliminary diagnoses were made, for which surgical treatment was performed: acute adhesive intestinal obstruction — 29 (56.9 %), gallstone ileus — 9 (17.6 %), acute bowel obstruction — 4 (7.8 %), acute mesenteric circulatory failure — 4 (7.8 %), acute cholecystitis — 3 (5.9 %), hernia — 1 (1.9 %), peritonitis — 1 (1.9 %). Gallstone obstruction was detected at different levels: in the duodenum — in 3 (5.9 %) patients, jejunum — in 17 (33.3 %), ileum — in 23 (45.1 %) and colon — 8 (15.7 %) patients. The cause of stones in the lumen of the digestive tract was cholecystoduodenal fistula — in 48 (94.1 %) and choledochoduodenal fistula — in 3 (5.9 %) patients. Diagnosis of biliary fistulas was performed during postoperative radiological and endoscopic examination. The scope of surgery was aimed at eliminating acute intestinal obstruction; enterotomy was performed 5–10 cm distal to the site of obstruction with lithoextraction. In one patient with areas of focal necrosis at the site of stone entrapment, a loop of the small intestine was resected with entero-enterostomy “side-by-side”. In case of duodenal obstruction, lithoextraction was performed through gastrotomy. In the perioperative period, 43 (84.3 %) patients received antibiotic prophylaxis using cephalosporines, fluoroquinolones and metronidazole. Purulent-septic complications in the postoperative period developed in 9 (17.6 %) patients: suppuration of the postoperative wound in 6, infiltrate of the abdominal cavity in 1 and bronchopneumonia in 2. Two patients died, postoperative mortality was 3.9 %. Conclusions. Gallstone intestinal obstruction is difficult to diagnose due to a variety of clinical manifestations and course, and, accordingly, it is accompanied by frequent complications and high mortality. Surgical treatment should eliminate intestinal obstruction in conditions of high surgical risk without repair of biliodigestive fistula. Early detection and determination of indications for planned surgical sanitation of the biliary tract is a reliable way to prevent gallstone ileus.

Aim: To study the features of morpho-functional changes in the small intestine mucosa in acute adhesive small bowel obstruction.Material and methods. The results of a comprehensive study of morphological and functional changes in the small intestine’s mucous membrane in 20 patients out of 50 with acute adhesive small intestinal obstruction were analyzed. Patients underwent resection of the small intestine with a biopsy from the mucous membrane, followed by a pathomorphological and biochemical examination of biopsy specimens.Results. The study results show that more pronounced pathomorphological changes in the mucous membrane of the small intestine were observed in patients with acute adhesive small intestinal obstruction with widespread (multiple) adhesions compared with limited (single) adhesions. In the study of biochemical parameters in the small intestine mucosa in patients with acute adhesive small intestinal obstruction with the presence of multiple (widespread) adhesions, there was a significant and critical increase in lipid peroxidation and proinflammatory cytokines, a decrease in antioxidant protection compared to the patient group with the presence of single (limited) adhesions. There was also a decrease in the concentration of serotonin in the mucosa of the small intestine. In the presence of single (limited) adhesions in these patients, it decreases to 0,50±0,3 units, and in patients with multiple (common) adhesions - to 0,20±0,2 arb. units.Conclusion. The severity of morpho-functional changes in the mucosa of the small intestine directly correlates with the severity of the development of the adhesive process and acute adhesive small bowel obstruction.

Проблема гострої спайкової кишкової непрохідності залишається однією з найбільш актуальних та складних у сучасній абдомінальній хірургії. Серед усіх видів непрохідності спайкова непрохідність кишечника зустрічається найчастіше і складає від 40,4 до 86 % випадків.Мета дослідження – оцінити рівень показників ендогенної інтоксикації у хворих із спайковою кишковою непрохідністю до та після оперативного втручання та встановити їх вплив на розвиток ускладнень в післяопераційному періоді.Матеріали і методи. У статі висвітлено результати обстеження 57 хворих із гострою спайковою кишковою непрохідністю. З них 26 пацієнтів прооперовано лапароскопічно, 31 – виконано лапаротомію із подальшою ліквідацією непрохідності. Проведено дослідження рівня маркерів ендогенної інтоксикації (середньомолекулярних пептидів та визначення еритроцитарного індексу інтоксикації) до операції та на 3 добу післяопераційного періоду.Результати досліджень та їх обговорення. Встановлено, що у хворих із гострою спайковою кишковою непрохідністю значно зростає рівень маркерів ендогенної інтоксикації до операції і ступінь зростання цих показників перш за все залежить від стадії перебігу кишкової непрохідності. На 3 добу після операції виявлено незначне зниження рівня ендогенної інтоксикації, що свідчить про додаткові механізми розвитку токсикозу після оперативного втручання.Висновки. Протягом дослідження ми не встановили значно достовірного взаємозв’язку між маркерами ендогенної інтоксикації та розвитком ускладнень у післяопераційний період. Виявлено тісний взаємозв’язок між часом відновлення моторної функції кишок та рівнем ендогенної інтоксикації, що свідчить про провідну роль кишечника у формуванні токсикозу в пацієнтів із спайковою кишковою непрохідністю.

Objective. To analyze the results of relaparotomy for the treatment of complications after surgery for various abdominal pathologies and to identify risk factors for mortality after this intervention. Materials and methods. We analyzed the treatment outcomes of 72 patients who underwent surgery at the Clinic of Surgery, Plastic Surgery, and Endoscopy of the Faculty of Postgraduate Education of Danylo Halytsky Lviv National Medical University (base – Department No. 2 of the Center for Surgery and Oncology of the Municipal Non­Profit Enterprise "1st Territorial Medical Association of Lviv") for the period from January 2021 to December 2024. Repeat interventions were performed mainly in patients who were treated for acute adhesive intestinal obstruction and colorectal cancer with its complications – 11 (15.3%) patients each. The vast majority of the complications studied (44.4%) required repeat surgery under general anesthesia (according to the Clavien–Dindo classification) and were accompanied by the onset of multiple organ dysfunction (45.8%). Results. In cases of peritonitis or intestinal obstruction, intra­abdominal bleeding, emergency relaparotomy was performed in 64 (88.9%) patients. In the remaining 8 (11.1%) patients, programmed reintervention was performed due to an unpredictable course of the pathology with its expected progression (acute mesenteric blood flow disorder) or for step­by­step sanitation of purulent­destructive foci (acute destructive pancreatitis with purulent­septic complications). Complications in the early period after relaparotomy occurred in most patients – 40 (55.5%), and in 16 (40%) of them, repeated interventions had to be performed to eliminate them, in particular, in 9 (22.5%) – once, in the remaining 7 (17.5%) – from 2 to 4 times. Thirty­nine patients died, and the postoperative mortality rate was 54.2%. Using multivariate analysis (Mann–Whitney U test), 4 predictors of mortality after relaparotomy were identified. Conclusions. Complications after surgical treatment of colorectal cancer and acute adhesive intestinal obstruction require relaparotomy. Multiple organ failure and sepsis are the most common complications after relaparotomy. Mortality after relaparotomy remains high. Complications of class IVa and above according to the Clavien–Dindo classification are the most significant predictor of mortality after relaparotomy.

Acute adhesive intestinal obstruction is a complex and often unpredictable pathology. Therefore, the study of the pathomorphological component of this problem is important for the selection of adequate surgical and conservative therapy of the disease.The aim of the study is to research the pathomorphological changes in the peritoneum in patients with acute adhesive intestinal obstruction and determine the basic patterns of adhesions.Material and methods. The study covered 117 operated patients with various acute diseases of the peritoneal cavity of an infl ammatory nature, which to varying degrees were accompanied by damage to the peritoneal mesothelium. Collection of material for morphological studies was performed according to standard requirements for the manufacture of histological specimens. Biopsies included areas of adhesive and peritoneal tissue.Results. Through the examination of peritoneal biopsy material in the event of local peritonitis was found that some mesotheliocytes developed pronounced dystrophic changes, in some cells with the transition to necrosis. The lumens of the vessels of the microcirculatory tract were moderately dilated, fi lled with erythrocytes, and stasis developed in some of them. The main component of the infl ammatory focus was the increase in catabolic processes that led to metabolic disorders in connective tissue, accumulation of breakdown products of fat and carbohydrate metabolism and the development of tissue acidosis.Summary. Adhesion disease is characterized by a great variety of pathomorphological picture, which is due to the phased development of infl ammatory and hyperproliferative processes, and that is fundamental in the pathogenesis of adhesive disease.

Objective: To improve the treatment and diagnostic algorithm for acute adhesive intestinal obstruction. Materials and methods: We have studied the results of surgical treatment of 114 patients with OCD, which included spiral computed tomography using phytocomposite in the preoperative examination complex. Results: The inclusion of CT examinations in the ТDA allowed patients of the 1st main group to operate in 21 (70%) cases in the first 6 hours after hospitalization, in the 2nd group, where patients were traditionally examined only in 6 patients (13%) Conclusion: The developed diagnostic algorithm for acute adhesive intestinal obstruction, including computed tomography in the examination, reduced the number of intraoperative, early postoperative complications and fatal cases in the main group by 1.6 times than in the 2 control group 2 (p>0.05), and by 1.4 times than in the 1 control group (p>0.05).

Summary. The aim of the work is to improve the results of treatment of patients with acute adhesive intestinal obstruction in the postoperative period by correcting the proteolytic activity of small intestinal contents
 Materials and methods. 62 patients were operated on for acute adhesive intestinal obstruction. All patients underwent nasogastrointestinal intubation with aspiration of intestinal contents and subsequent prolonged intestinal decompression.
 Research results. In the second group, after intestinal lavage with α-aminocaproic acid, a decrease in total proteolytic activity was observed both in the contents of the small intestine and in blood serum.
 Conclusions. The use of intestinal lavage with the use of aminocaproic acid leads to a faster normalization of total proteolytic activity both in the contents of the small intestine and in the blood serum, to a decrease in the α1-antiproteinase inhibitor, proteolysis index, and also contributes to an earlier elimination of intestinal paresis.

Surgical treatment of acute adhesive intestinal obstruction is an unsolved problem due to the high frequency of relapses. The aim of this work was to improve the results of treatment of patients with acute adhesive intestinal obstruction by preventive measures improvement. The paper set out the principles of curative and prophylactic algorithm, that can help to reduce the frequency of relapses and improve long-term results. The algorithm includes operative treatment using endovideosurgical access and differentiated approach to the use of preventive measures. The best results were achieved by per- forming planned surgical operations.

ObjectiveTo determine the role of multidetector computed tomography (MDCT) with multiplanar (MPR) and curved multiplanar reformations (CMPR) in the detection of the cause of intestinal obstruction.Materials and methodsA retrospective analysis of 200 patients with a clinical suspicion of intestinal obstruction referred to the department of radiology, Dr. Ziauddin University Hospital, Clifton campus, from September 2016 to October 2019, was done. All patients who underwent an MDCT scan with oral and intravenous (I/V) contrast were included in the study. Patients with deranged serum creatinine and an allergic reaction to contrast were excluded from the study. MPR and CMPR images were acquired in each patient in addition to routine axial images. The causes of intestinal obstruction as determined by a computed tomography (CT) scan were confirmed on surgery and colonoscopy. The CT scans were analyzed by an independent radiologist with five years of experience blinded to the surgical and colonoscopy findings in detecting the cause of bowel obstruction using the axial, MPR, and CMPR images. Data analysis was done on IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY).ResultsOut of 200 patients with a clinical suspicion of intestinal obstruction, 120 patients with intestinal obstruction was confirmed on CT scan. Fifty-eight patients were males (48.33%) and 62 patients were females (51.66%) with a male-to-female ratio of 1:1.06. The mean age of the patients was 54.7 years (age range from 06 years to 85 years). Abdominal distension was the most common presentation seen in 37 patients (30.83%) followed by vomiting in 25 patients (20.83%). Small bowel obstruction was seen in 96 patients (80.00%) with the ileum being the most common site of obstruction seen in 76 patients (63.33%). Among the patients with the ileum being the site of obstruction, distal ileal obstruction was seen in the majority of patients (30 patients, with a frequency of 25.00%). Twenty-three patients (19.16%) had a large bowel obstruction, with sigmoid colon involvement seen as the most common site in 10 patients (8.33%). Adhesions were the leading extrinsic cause of bowel obstruction seen in 32 patients (26.6%). Intraluminal causes of obstruction were seen in 36 patients (30.0%) with carcinoma being the commonest cause (12 patients with a frequency of 10.0%). A foreign body is the primary cause of intraluminal obstruction (three patients, with a frequency of 2.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT were 86.2%, 92.7%, 90.1%, and 96.4%, respectively.ConclusionMDCT has high sensitivity and specificity to diagnose and determine the cause of bowel obstruction. It not only determines the site of obstruction but also the cause of obstruction, including intrinsic, extrinsic, and intraluminal causes.

Intestinal obstruction is a common general surgical emergency with high morbidity and mortality. Its aetiology varies widely between and within geographic regions, with gender, age, and time. Obstructed inguinal hernia is still considered the most common cause of intestinal obstruction in Sub-Saharan Africa and other low-income countries, but its incidence appears to be on the decrease as other causes of intestinal obstruction become more common in a particular society. To examine the spectrum of causes of intestinal obstruction in a tertiary hospital in southern Nigeria and compare the results with earlier studies in the region and Nigeria. A cross sectional, single-hospital study of adults diagnosed with and having clinical and radiological features of acute intestinal obstruction. Seventy patients were enrolled in the study, comprising of 35 (50%) males and 35 (50%) females, M:F = 1:1. The mean patient age was 44.8 years. Two peak age incidences of intestinal obstruction were observed in the 36-45 and 56-65 years age groups. Post-operative adhesion 13 (18.5%), obstructed external abdominal hernia 13 (18.5%), colonic cancer 11 (16%), and intussusception seven (10%) were the primary causes of intestinal obstruction. Obstructed inguinal hernia was commonly encountered in males while adhesions and colonic cancers were common in females. Obstructed external abdominal hernias and post-operative adhesion are at par as the main primary causes of intestinal obstruction. Colon cancer and intussusception are increasingly causing more obstructions.

The quality of life of patients undergoing surgery is a subjective measure of psychological and physical well-being. In order to assess the quality of life indicators, the results of a survey conducted using the Russified questionnaires SF-36 v.2 and AQLi were analyzed. The aim of the study was to determine the dynamics of the quality of life of patients before and after undergoing surgery. The application of the new AQLi scale will make it possible to objectify the indications for surgical intervention, namely, when the Summ value is less than 65 and the SBP is reliably confirmed by instrumental research methods, the performance of planned adhesiolysis is shown. The main indicators in the group of patients with acute adhesive intestinal obstruction, operated on by the laparoscopic approach, had higher values and came to normal earlier than those in the group with the laparotomic access, which indicates a better tolerance of laparoscopic surgical interventions in this pathology.

There are presented results of therapeutic-diagnostic laparoscopy in 317 children with various pathologies of the abdominal cavity organs, aged from 2 to 15 years. Among patients there were 163 children with acute appendicitis and its complications, 68 girls with acute pathologies of pelvic organs, 39 cases with the acute adhesive intestinal obstruction, 14 - with intussusception, 11 patients with pathology of Meckel diverticulum, 5 - with acute cholecystitis, 5 - with cystic doubling intestine - and 6 - with intestinal mesentery tumor. Diagnostic laparoscopy also revealed acute mesadenitis in 4 cases, and urolithiasis was diagnosed in 2 cases. In the treatment and diagnostic laparoscopy, the switch to the conversion was noted in 19 (5.9%) cases. In 298 (94.1%) cases, the treatment and diagnostic laparoscopy was effective and in these patients positive results were noted

Anomalous congenital bands are rare causes of intestinal obstruction in children, adults, and neonates. They are rarely reported, and their etiopathogenesis is unknown, without malrotation in children. Their presentation and radiographic features are similar to any acute intestinal obstruction. The author found approximately 50 similar cases in the literature; however, during and after COVID-19 pandemic, this is the first case of anomalous congenital obstructing band without mal rotation to be reported to date. This is a rare case of infantile intestinal obstruction managed during COVID-19 pandemic. Acute intestinal obstruction due to a congenital anomalous band is rare in infants and children, and if not treated promptly, can lead to morbidity and mortality. Various reasons, such as congenital, acquired, and extrinsic or intrinsic pathologies in children and adults, may be the cause for acute intestinal obstruction. Congenital anomalous bands account for 3% of the intestinal obstructions in infants and children. These bands may cause ischemia and gangrene of the bowel without timely intervention.

Introduction: Intestinal obstruction has emerged as a challenging emergency putting unwanted financial as well as clinical burden globally. A study on etiology, symptoms, and management could benefit in treating larger population of the region. Aim: The study aimed to study the demography, etiology, symptoms, and management of intestinal obstruction among a population in central India. Materials and Methods: A single-center prospective observational study of intestinal obstruction was done among patients admitted to various surgical wards, during the period from January 1, 2018, to May 31, 2019. Here, we studied 50 cases of intestinal obstruction. Patients belonged to the age groups ranging from 15 to 85 years were included. Patients were selected on the basis of clinical history, physical findings, and radiological and hematological investigations. For statistical analysis, Chi-square and Fisher exact tests were performed. Results: There were a total of 12,233 admissions among which 228 cases were acute intestinal obstruction, we randomly selected 50 cases for the present study. Males were 72% (n = 36) and females were 28% (n = 14). The age groups 31–40 (20%) and 51–60 (20%) showed the highest incidence. Postoperative adhesions (40%), obstructive hernia (30%), and malignancy (14%) were the major causes of obstruction. Surgical intervention was carried out with release of adhesions in majority of cases (40%), resection anastomosis in 22%, and release of adhesions with herniorrhaphy in 18% of cases. Pain in the abdomen was a major symptom (88%) among the cases. The mortality rate was 14% of the total subjects involved in the study. Conclusion: Acute intestinal obstruction remains an important surgical emergency in the surgical field, success in the treatment depends largely upon early diagnosis and proper management and treatment of pathological effects of the obstruction. Postoperative adhesions are one of the main causes responsible for intestinal obstruction.

Acute abdomen: intestinal obstruction